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GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received ~/~ L~ /~J~//
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
4,
5.
6.
Approval requested by:
Mailing Address: J~/~, xx//~C~/~ ~<, .J~ ~y¢~hone:
Property Owner: ~¢~
Mailing Address: ~?~
Legal Description:
Location: ~/~/
Type of facility to be inspected
No. of bedrooms
Well Data:
C Construction ~///m.~/ D. Bacterial Analysis
Sewage Disposal System: ~x/~x~/~ ~~k~~y/
A. Installed .~.~//.L~-~'/~Z~/ B. Installer
C. Septic Tank: 1. Size /yY~ 2. Manufacturer
D. Seepage Pit: 1. Absorption Area
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank /~/+~, Absorption area /~ A~ . ., Sewer Lines
Nearest lot line ~' , Other contamination /J~,~.'~. /tV, M~//''1
B. Foundation to septic tan~/~/~/ , Absorption area ~.~?~ ~/
C. Absorption area to nearest lot line ~y~ /~ /
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Request for Approval of Individual . fl;er & Water Facilities
Legal Description ~z//I~' ~y d?~-'3~'7-/--d)~
Comments ~~/~~ ~- ~/~~ ~' ~/~
Approved
Approval Valid for one year from date signed
Greater Anchorage Arda Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operati~ sfactor] 1 y..
EQ-034 (1/74)
Date /~-~,~-75/